Outcomes of total hip arthroplasty in haemodialysis and renal transplant patients: systematic review.

BACKGROUND: Chronic renal failure is increasing in prevalence and reported to have deleterious effects on the outcome of total hip arthroplasty (THA). AIM: To investigate the clinical and functional outcomes of THA in patients receiving haemodialysis or who have previously undergone renal transplantation. METHODS: Systematic review of the literature using bibliographic databases up to July 2018 to determine the functional outcome, complications and revision rates of THA in patients receiving haemodialysis for end-stage renal failure and those with a previous renal transplant. RESULTS: 25 studies were identified with a total of 797 THAs. 166 patients (20.8%) were receiving haemodialysis and 631 patients (79.2%) had undergone transplantation. All studies reported a marked improvement in hip function following THA. There were 27 failures (15.7% revision rate) in the haemodialysis group and 101 failures (16.0% revision rate) in the transplant group. The revision rate for cemented implants was higher in haemodialysis versus transplant patients (23% vs. 15%), with the converse being true for uncemented implants (3.8% vs. 6.9%). The deep infection rate was higher in the haemodialysis group (10.8% vs. 2.1%). CONCLUSIONS: Patients receiving haemodialysis or with a history of renal transplantation can expect good functional outcome following THA. However, the revision rate and deep infection rate are higher than would be expected in patients receiving THA for primary OA. Aseptic loosening is the most common reason for revision. Uncemented implants appear to be associated with lower failure rates both in haemodialysis patients and those who have had a transplant.

Tibial fixation without screws in cementless knee arthroplasty.

This study reexamines the clinical and radiologic results of the first 216 cases of a cementless fixed-bearing tibial tray without screw holes in 191 patients at 7.6-year follow-up (range, 5-10 years). Mean Hospital for Special Surgery scores improved from 54/100 preoperatively to 84/100 postoperatively. Four tibial baseplates were revised. Five polyethylene inserts were revised. The overall reoperation rate was 12%. Four percent of tibial baseplates had incomplete nonprogressive radiolucent lines involving 1 or 2 of 10 defined zones. Overall tibial osteolysis rate was 4.1%. All tibial components were stable by radiographic technique. We conclude that this tibial tray provides reliable stability without the use of screws at medium-term follow-up. The polyethylene failure rate is a concern.